North Korea heads the list, released Wednesday, for the 10th consecutive year. This is the first time that the other nine are all Islamist nations, according to the Santa Ana, Calif.-based organization, which counts 38 Islamist nations on its list of 50.

Afghanistan moved to its highest ranking in the list’s history at No. 2. Rounding out the top 10 are Saudi Arabia, Somalia, Iran, Maldives, Uzbekistan, Yemen, Iraq, and Pakistan.

“Christians often face persecution from extremists, the government, their community and even their own families,” said Carl Moeller, president and CEO of Open Doors USA. “While many thought the Arab Spring would bring increased freedom, including religious freedom for minorities, that certainly has not been the case so far.”

North Korea deserves the dubious top spot on the list, Open Doors said. With a quasi religion built around Kim Il Sung, who founded the country, individuals with another god are persecuted. An estimated 200,000 to 400,000 Christians in North Korea remain underground, and around 50,000 to 70,000 Christians in the country are confined to prison camps, the organization reported.

“Certainly the situation for believers remains perilous,” Moeller said. “Please pray with me that the Lord will open up North Korea and there will be religious freedom to worship the one, true God, not the gods of Kim Jong Il and Kim Il Sung.”

North Korea, Saudi Arabia, Iran, and Uzbekistan are the only representatives on the list from the eight nations that the State Department designates as “countries of particular concern” for violations of religious freedoms. Others are Eritrea at 11th; Sudan at 16; China, 21; and Burma, 33.

The Open Doors rankings are compiled from questionnaires that members of Christian ministries answer and experts evaluate.